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Monday, 10 June 2013

In this month's blog post, Stephen Bance, MA student at the Centre for the History of Medicine in Ireland, University College Dublin, writes about his research project on the history of polio in Ireland, 1940-1970.

Polio and history

One of the first recorded polio epidemics occurred on the island
of Saint Helena, a British colony, in 1836. Outbreaks followed later in the century in Norway,
France, Sweden and America. By March
1955, the World Health Organisation recognised that polio was ‘a
practically world-wide disease’. In Ireland, polio was
scarcely known prior to 1940. The first significant epidemic occurred in 1942 andthe incidence of the disease fluctuated during the following years.The worst epidemic wave occurred in 1956, when approximately 500 cases were
notified nationwide. Yet, with the exception of Laurence Geary’sshort overview of the epidemic in Cork, polio has been largely ignored
in Irish history. An exploration of polio in Ireland will provide a new
lens through which to critique public health legislation in the mid-twentieth
century and uncover Irish lay and medical understandings of disease. It will
contribute to the Irish literature on the epidemiology of diseases, eradication
programmes and public health policies, which, to date, has focused primarily on tuberculosis.

Group of polio andarthritic patients on the sundeck, USA, undated photograph. Courtesy of the National Library of Medicine, Images from the History of Medicine Collection. A015237

Polio project structure

The project is divided into three thematic sections:

1.
What was the geographic and demographic distribution of polio?

This
section of the project maps the incidence of the polio epidemic at a
regional level with a view to revealing the topography of the disease. While
the impact of the 1956 epidemic upon Cork has received analysis, little is
known of polio consequences nationally or, indeed, whether its effects
varied in urban and rural environments. In addition, the study will provide a
demographic profile of its victims in terms of age, sex, marital status, class
and outcome. It will also interrogate the types and forms of diagnosis and
treatment assigned to sufferers. This data will establish whether the gender,
class and age of sufferers impacted on susceptibility to the virus and on
access to treatment and vaccination.

2.
What were the social and cultural meanings assigned to polio and to its
victims?

In his study of the American experience of polio, David Oshinsky contextualized the outbreak within the
increasingly suburban, family-oriented, and hygiene obsessed 1950s, arguing
that the nation’s most affected by polio were considered to be the most
hygienic and least at risk to infectious diseases. The impact these domestic
hygienic practices had on Ireland in the 1940s and 1950s is unclear, however it
would appear that medical research on the epidemiology of the virus in Ireland
examined whether the Irish were racially susceptible to the disease; an
anti-body survey carried out by the Medical Research Council in 1956 revealed
that antibody levels among Irish children were dangerously low. Examining medical research into disease aetiology conducted in Ireland, the
study will uncover the social and cultural assumptions underpinning theories of
susceptibility to polio.

Polio epidemics were capable of generating widespread fear and apprehension within the communities affected.In a contemporary
account of the 1956 Cork epidemic, Patrick Cockburn suggested that public fear of
the disease outlasted its virulence within society and the possibility of its
return terrified communities. Drawing on newspapers,
correspondence and memoirs, the study will look at the social responses to
polio, especially the widespread fear of the disease and the consequent
stigma attached to sufferers and groups who were identified as likely carriers
of the virus. It will consider whether ‘fear’ had a negative impact upon public
health initiatives, thereby exploring how social histories of diseases can
become intertwined with political and policy narratives.
Government press releases and publicity campaigns will give insight into the
state’s efforts to assuage public terror. By situating the Irish experience
within the international context, the study will consider whether there was
universality to social reactions to polio in the twentieth century.

3.
What was the public health response to polio in Ireland and how
successful was it?

In
his pioneering work on the history of public health, George Rosen argued that
the protection and promotion of public health and welfare was one of the most
important functions of the modern state. For Ireland
however, it has been demonstrated that ‘few local authorities approached the
problem of eradicating infectious disease with determination’ and only
belatedly did public health became a matter of major public concern in the
1950s. James Deeny attested to a
political disinterest in public health, concluding that in the case of
tuberculosis, the Irish government ‘had been hoping the problem would go away’. Did they harbour similar hopes for polio? Preliminary
research has revealed that Irish health authorities were slow to respond to the
threat of polio, while specialist centres for
treatment were only established fifteen years after the disease had been made
notifiable. A Salk vaccination programme was introduced to
Ireland in 1957, this was significantly later than in France, America and
Britain.

A forgotten epidemic

This
section will examine the public health response to the epidemic at a local and
national level, revealing the tensions at play that led to delays in
implementing vaccination programmes and other initiatives. It will interrogate
whether these failings were a result of underdeveloped public health
infrastructure, politico-religious conservatism, an inert bureaucracy,
economics or other factors. In addition, correspondence between public health
bodies, the Medical Research Council and the Department of Health will reveal
the factors informing the delivery of the vaccination programme; who was
identified as especially vulnerable to the disease and why? The study will then
uncover the impact delays in developing a robust public health response had on
infection and mortality rates, especially among children, as Dr Noel Browne
later lamented. By uncovering a near forgotten epidemic of 1950s
Ireland, this project will add greater depth and sophistication to the
literature on Irish health policy and infectious disease eradication.